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WARNING It is a criminal violation to make false statements on vital records application forms or to fraudulently obtain a birth certificate. Punishment may include a civil penalty of up to $5,000.00 and up to five years in prison. Utah Code, Sections 26-23-5, 26-23-5.5 and 26-23-6.

NOTE This is an online application only. Please do not print this page and mail it to our office. If you would prefer to mail an application, please click here.

 
* Indicates a required field
  Certificate Holder Information
  Name on Certificate
*First
Middle
*Last
   
*Date of Birth
(mm / dd / yyyy)
*City of Birth
*County of Birth
*Gender
*Still Living
   
 
Name of Father
*First
Middle
*Last
 
Name of Mother
*First
Middle
*Maiden
   
 

Applicant Information

NOTE Applicant must use his or her own credit card and the certificate will be mailed to the credit card billing address.

 
Your Name
*First
Enter your name exactly as it appears on your credit card.
Middle
*Last
   
*Home Phone
Please include area code.
Work Phone
Ext.
E-mail Address
   
  Credit Card Billing Address
Certificate(s) will be mailed to this address.
*Address
*City
  Leave State blank if mailing address is not in United States or Canada.  Country will be entered on credit card information page.
State
*Zip/Postal Code
   
Your Relationship to the Certificate Holder

NOTE Only members of the immediate family are eligible to receive a copy of a birth certificate.  This includes; spouse, child, parent, legal guardian or designated legal representative, sibling, grandchild, (maternal) grandparent or (paternal) grandparent if the father is listed on the birth certificate.

*Your relationship to the certificate holder
If Other, please specify
*Reason for requesting certificate

The $18 search fee includes a certified copy of the birth certificate.  If you would like to order any additional copies of this birth certificate at this time, please specify the quantity:

Additional certified copies
x $8.00 each

Total Due